Pericardial Effusion, Malignant Workup

  • Author: Poothirikovil Venugopalan, MBBS, MD, FRCP(Glasg), FRCPCH; Chief Editor: Stuart Berger, MD   more...
 
Updated: Jun 25, 2010
 

Laboratory Studies

  • Blood investigations as dictated by the general condition
    • CBC count with platelet count and WBC differential
    • Blood film (smear)
    • Serum chemistry
    • Erythrocyte sedimentation rate (ESR)
    • C-reactive protein (CRP)
    • Blood cultures
  • Markers of specific malignancy may help in following disease progression
    • Serum alpha fetoprotein
    • Serum caner antigen (CA) 125
  • Markers of malignancy in pericardial fluid cells
    • Human telomerase reverse transcriptase (hTERT) mRNA expression may be detected in abnormal cells in body fluids using in situ hybridization (ISH).
    • Molecular genetic studies can also be helpful in the analysis of lymphocyte-rich serous pericardial effusion.
    • Immunocytochemical panel of tests has also been suggested in selected cases.
  • Electrocardiography
    • Changes are nonspecific and may represent the effect of pericardial inflammation on the underlying myocardium.
    • Low voltage QRS complexes (35%) are seen.
    • ST-segment elevation is found.
    • T-wave inversion is seen.
    • Development of arrhythmias (atrial tachycardia, atrial fibrillation, heart block) is observed.
    • Electrical alternans (17%), a beat-to-beat variation in QRS amplitude, occurs with excessive motion of the heart within the fluid-filled pericardial space.
Next

Imaging Studies

  • Chest radiography
    • Chest radiography reveals a varying degree of cardiomegaly, depending on the amount of pericardial fluid and its rate of accumulation (see the image shown below). Plain chest radiograph in a 3-month-old infant witPlain chest radiograph in a 3-month-old infant with pneumonia and malignant pericardial effusion showing cardiomegaly and bilateral pneumonic patches.
    • Rapidly accumulating effusion is associated with relatively minimal cardiomegaly.
    • Massive effusions produce a large cardiac shadow, causing the characteristic water-bottle heart or triangular heart with smoothed-out cardiac borders.
    • Pleural effusion, mediastinal widening, hilar mass, or, less commonly, irregular nodular contour of the cardiac silhouette or a bony or parenchymal metastatic deposit may indicate underlying disease.
    • Rarely, pericardial calcification may be evident.
  • Echocardiography
    • Echocardiography is the primary study performed for diagnosis and quantification of the effusion, as well as for guiding needle pericardiocentesis. Echocardiography has a 96% diagnostic accuracy in pericardial effusion.
    • Pericardial fluid gives the appearance of an echo-free space between the epicardial and pericardial reflections. This is evident in both 2-dimensional images and M-mode images. Refer to the images below. Two-dimensional echocardiograph from a subcostal wTwo-dimensional echocardiograph from a subcostal window showing a large pericardial effusion. M-mode echocardiograph in a child with pericardialM-mode echocardiograph in a child with pericardial effusion.
    • When effusion is minimal, it accumulates posterior to the left ventricle and is more apparent in systole.
    • When effusion is massive, fluid is observed all around the heart and throughout the cardiac cycle.
    • Diastolic ventricular filling is abnormal secondary to cardiac compression.
    • A swinging motion of the heart may be observed within the pericardial cavity, along with abnormalities of septal motion, dilation of the inferior vena cava, and loss of respiratory caval motion.
    • Irregular undulating masses that protrude into the pericardial space, atria, ventricles, or even into the pulmonary arteries are reported.
    • Fetal echocardiography can identify fetal pericardial effusion secondary to fetal pericardial malignancy (most commonly teratoma).
  • CT scanning
    • CT scanning reveals the thickness and density of the pericardium and content of the pericardial space.
    • CT scanning aids in identification of constrictive pericarditis by providing additional information on the status of the vena cava, atria, ventricles, and pleural changes.
    • The minimum amount of pericardial fluid that can be detected by CT scanning is estimated to be 10 mL.
    • CT scanning provides added information regarding the presence and location of space-occupying masses within the pericardium and adjacent mediastinum and lungs.
  • Transesophageal echocardiography (TEE): This provides information regarding the presence and location of space-occupying masses within the pericardium.
  • MRI: MRI provides added information regarding the presence and location of space-occupying masses within the pericardium and adjacent mediastinum and lungs. In addition, this technique is more sensitive in differentiating malignant lesions from benign ones.
  • Radionuclide imaging: This can demonstrate a pericardial effusion in previously undiagnosed pericardial disease.
Previous
Next

Procedures

  • Pericardiocentesis
    • This is used to diagnose cause, assess cytology, and treat hemodynamic compromise in the presence of cardiac tamponade.
    • Malignancy may be first suspected from pericardial fluid analysis in as many as 5% of such patients.
    • Catheter drainage technique is commonly used.
    • Ultrasonographic guidance adds to the safety of the procedure but is not a requisite with emergency drainage.
    • Insert a beveled, sharp needle beneath the xiphoid process and angle upward and leftward toward the left shoulder. Sometimes, a pop is felt as the needle is passed into the pericardium.
    • Attempts to withdraw fluid are made with each advance of the needle.
    • If fluid is obtained, remove enough to alleviate tamponade. Even a small amount often provides significant benefit.
    • Process the pericardial fluid for cytology, biochemistry, and culture and sensitivity, including viral and fungal cultures in relevant cases.
    • Exudates differ from transudates by demonstrating higher leukocyte counts, lower glucose, higher protein contents, and higher specific gravity.
    • Cytospin preparations can be stained with Wright-Giemsa stain to identify cellular morphology that, in turn, can be used to test for immunologic markers and for electron microscopy.
    • Complications are myocardial puncture, coronary artery or vein laceration, hemopericardium, laceration of the internal mammary artery, pneumothorax, and liver and aortic injury.
    • In the presence of significant effusion, maintain good hydration and effective filling pressures to help maintain perfusion until pericardiocentesis can be performed.
  • Closed drainage technique
    • Continuous drainage of the pericardial space is accomplished by advancement of a pigtail catheter over a guide wire.
    • This is necessary for patients in whom the effusion reaccumulates rapidly.
  • Pericardioscopy: This can reveal neoplastic effusions by direct observation and by obtaining a biopsy of the pericardium for further analysis.
  • Video-thoracoscopic pericardial drainage is a safe and effective for loculated pericardial effusions previously treated by percutaneous drainage maneuvers and patients with concomitant pleural disease.[89]
  • Fetal pericardiocentesis: This has been used in the treatment of pericardial effusion secondary to fetal teratoma.
  • Pericardioamniotic shunting has been tried in fetal malignant pericardial effusion, with variable success.[87]
  • Pericardial biopsy
    • Specimens can be obtained by open pericardiotomy or during thoracotomy (rare). Pericardial biopsy has a sensitivity of approximately 55% for diagnosing malignant involvement; however, together with cytology of the pericardial fluid, pericardial biopsy provides nearly 100% sensitivity.
    • Open pericardial biopsy may be required if initial cytology is negative. Obtaining a larger biopsy specimen by open biopsy should provide a histologic diagnosis in up to 90% of cases. The procedure carries significant risk in patients who are critically ill, but a false-negative diagnosis may occur if the tissue sample is too small.
    • Biopsy specimens are subjected to histologic and immunohistologic evaluations, polymerase chain reaction, or in situ hybridization analysis for microbial DNA and ribonucleic acid.
  • Cardiac catheterization: This is not required for diagnosis of pericardial effusion. Potential indications for cardiac catheterization include the following:
    • Suspected superior venacaval obstruction and pulmonary microvascular tumor (lymphangitic tumor) may occur with malignant cardiac tamponade and contribute to the development of facial edema and jugular venous distension.
    • Cyanosis, hypoxemia, and elevated pulmonary vascular resistance may indicate pulmonary microvascular tumor (lymphangitic tumor). The diagnosis can be established by obtaining a blood sample for cytologic analysis from the pulmonary capillary wedge position using the right heart catheter.
Previous
Next

Histologic Findings

  • Malignant pericardial effusion is often hemorrhagic or serosanguineous, but this alone does not differentiate among neoplastic, radiation, or idiopathic causes. Because treatment strategies differ, carrying out a meticulous cytologic examination of the fluid (see images below) is essential in an attempt to differentiate malignant pericarditis from other causes. False-negative cytology is uncommon in carcinomatous pericarditis but, when it occurs, it may be due to scant cellularity or the presence of obscuring blood. False-negative results are more common with lymphoma and mesothelioma. Chylothorax is most often reported with mediastinal lymphangioma. Cytologic features of malignant pericardial effusiCytologic features of malignant pericardial effusion. Smear of centrifuged pericardial fluid in a patient with malignant pericardial involvement from lymphoma. Low-power view showing numerous mononuclear cells along with large atypical malignant cells. Cytologic features of malignant pericardial effusiCytologic features of malignant pericardial effusion. Smear of centrifuged pericardial fluid in a patient with malignant pericardial involvement from lymphoma. High-power view showing morphologic details of the malignant cells. These cells are large and show oval hyperchromatic nuclei, some of them having nucleoli. The cytoplasm is reduced to a thin rim.
  • Detection of malignant cells in effusions is facilitated by the use of immunocytochemistry, using a wide panel of antibodies. BerEP4 and B72.3 appear to be the best markers when both sensitivity and specificity are considered, followed by BG8. Carcinoembryonic antigen (CEA) and CA-125 have a limited role in detection of metastases from gynecologic tumors because of the low sensitivity of CEA and the low specificity of the CA-125.
  • Flow cytometry can also be used to detect DNA diploidy (benign) and aneuploidy (malignant), but the results have not been uniformly convincing. The low sensitivity of flow cytometric DNA analysis does not favor routine use.
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Poothirikovil Venugopalan, MBBS, MD, FRCP(Glasg), FRCPCH,  Consulting Staff, Department of Child Health, University Hospital of North Tees and Hartlepool, UK

Poothirikovil Venugopalan, MBBS, MD, FRCP(Glasg), FRCPCH, is a member of the following medical societies: British Cardiac Society, Royal College of Paediatrics and Child Health, and Royal College of Physicians and Surgeons of Glasgow

Disclosure: Nothing to disclose.

Specialty Editor Board

Ira H Gessner, MD  Professor Emeritus, Pediatric Cardiology

Ira H Gessner, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Hugh D Allen, MD  Professor, Department of Pediatrics, Division of Pediatric Cardiology and Department of Internal Medicine, Ohio State University College of Medicine

Hugh D Allen, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, American Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Gilbert Z Herzberg, MD  Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center

Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD  Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

References

  1. Thomas-de-Montpreville V, Nottin R, Dulmet E, Serraf A. Heart tumors in children and adults: clinicopathological study of 59 patients from a surgical center. Cardiovasc Pathol. Jan-Feb 2007;16(1):22-8. [Medline].

  2. Bien E, Stefanowicz J, Aleszewicz-Baranowska J, et al. [Cardio-vascular disorders at the time of diagnosis of malignant solid tumours in children--own experiences]. Med Wieku Rozwoj. Jul-Sep 2005;9(3 Pt 2):551-9. [Medline].

  3. Ben-Horin S, Bank I, Guetta V, Livneh A. Large symptomatic pericardial effusion as the presentation of unrecognized cancer: a study in 173 consecutive patients undergoing pericardiocentesis. Medicine (Baltimore). Jan 2006;85(1):49-53. [Medline].

  4. Medary I, Steinherz LJ, Aronson DC, La Quaglia MP. Cardiac tamponade in the pediatric oncology population: treatment by percutaneous catheter drainage. J Pediatr Surg. Jan 1996;31(1):197-9; discussion 199-200. [Medline].

  5. Abadi MA, Zakowski MF. Cytologic features of sarcomas in fluids. Cancer. Apr 25 1998;84(2):71-6. [Medline].

  6. Arya LS, Narain S, Thavaraj V, et al. Leukemic pericardial effusion causing cardiac tamponade. Med Pediatr Oncol. Apr 2002;38(4):282-4. [Medline].

  7. Ascoli V, Taccogna S, Scalzo CC, Nardi F. Utility of cytokeratin 20 in identifying the origin of metastatic carcinomas in effusions. Diagn Cytopathol. Jun 1995;12(4):303-8. [Medline].

  8. Bardales RH, Stanley MW, Schaefer RF, et al. Secondary pericardial malignancies: a critical appraisal of the role of cytology, pericardial biopsy, and DNA ploidy analysis. Am J Clin Pathol. Jul 1996;106(1):29-34. [Medline].

  9. Bath LE, Walayat M, Mankad P, et al. Stage IV malignant intrapericardial germ cell tumor: a case report. Pediatr Hematol Oncol. Sep-Oct 1997;14(5):451-5. [Medline].

  10. Batlle M, Ribera JM, Larrousse E, et al. Cardiac tamponade as the initial manifestation of acute leukemia: report of a case and review of the literature. Haematologica. Nov-Dec 1991;76(6):505-7. [Medline].

  11. Benatar A, Vaughan J, Nicolini U, et al. Prenatal pericardiocentesis: its role in the management of intrapericardial teratoma. Obstet Gynecol. May 1992;79(5 ( Pt 2)):856-9. [Medline].

  12. Braunschweig R, Guilleret I, Delacretaz F, et al. Pitfalls in TRAP assay in routine detection of malignancy in effusions. Diagn Cytopathol. Oct 2001;25(4):225-30. [Medline].

  13. Cartagena AM, Levin TL, Issenberg H, Goldman HS. Pericardial effusion and cardiac hemangioma in the neonate. Pediatr Radiol. 1993;23(5):384-5. [Medline].

  14. Ceresoli GL, Ferreri AJ, Bucci E, et al. Primary cardiac lymphoma in immunocompetent patients: diagnostic and therapeutic management. Cancer. Oct 15 1997;80(8):1497-506. [Medline].

  15. Chan HS, Sonley MJ, Moes CA, et al. Primary and secondary tumors of childhood involving the heart, pericardium, and great vessels. A report of 75 cases and review of the literature. Cancer. Aug 15 1985;56(4):825-36. [Medline].

  16. Chang JS, Young ML, Chuu WM, Lue HC. Infantile cardiac hemangioendothelioma. Pediatr Cardiol. Jan 1992;13(1):52-5. [Medline].

  17. Cullinane CA, Paz IB, Smith D, et al. Prognostic factors in the surgical management of pericardial effusion in the patient with concurrent malignancy. Chest. Apr 2004;125(4):1328-34. [Medline].

  18. Czader M, Ali SZ. Flow cytometry as an adjunct to cytomorphologic analysis of serous effusions. Diagn Cytopathol. Aug 2003;29(2):74-8. [Medline].

  19. da Costa CM, de Camargo B, Gutierrez y Lamelas R, et al. Cardiac tamponade complicating hyperleukocytosis in a child with leukemia. Med Pediatr Oncol. Aug 1999;33(2):120-3; discussion 124. [Medline].

  20. Daubeney PE, Ogilvie BC, Moore IE, Webber SA. Intrapericardial lymphangioma presenting as neonatal cardiac tamponade. Pediatr Cardiol. Mar-Apr 1996;17(2):129-31. [Medline].

  21. Davidson B. Malignant effusions: from diagnosis to biology. Diagn Cytopathol. Oct 2004;31(4):246-54. [Medline].

  22. Davidson B, Risberg B, Kristensen G, et al. Detection of cancer cells in effusions from patients diagnosed with gynaecological malignancies. Evaluation of five epithelial markers. Virchows Arch. Jul 1999;435(1):43-9. [Medline].

  23. del Barrio LG, Morales JH, Delgado C, et al. Percutaneous balloon pericardial window for patients with symptomatic pericardial effusion. Cardiovasc Intervent Radiol. Sep-Oct 2002;25(5):360-4. [Medline].

  24. Donadieu J, Canioni D, Cuenod B, et al. A familial T-cell lymphoma with gamma delta phenotype and an original location. Possible role of chronic Epstein-Barr virus infection. Cancer. Apr 15 1996;77(8):1571-7. [Medline].

  25. Eyskens B, Lawrenson J, Moerman P, et al. Brief report. Sudden death following removal of pericardial fluid in a child presenting with mediastinal lymphoma. Med Pediatr Oncol. Dec 1998;31(6):547-8. [Medline].

  26. Fang BR, Chiang CW, Hung JS, et al. Cardiac myxoma--clinical experience in 24 patients. Int J Cardiol. Dec 1990;29(3):335-41. [Medline].

  27. Fernandes F, Ianni BM, Arteaga E, et al. Value of pericardial biopsy in the etiologic diagnosis of pericardial diseases [in Portuguese]. Arq Bras Cardiol. Jun 1998;70(6):393-5. [Medline].

  28. Geissbuhler K, Leiser A, Fuhrer J, Ris HB. Video-assisted thoracoscopic pericardial fenestration for loculated or recurrent effusions. Eur J Cardiothorac Surg. Oct 1998;14(4):403-8. [Medline].

  29. Georghiou GP, Stamler A, Sharoni E, et al. Video-assisted thoracoscopic pericardial window for diagnosis and management of pericardial effusions. Ann Thorac Surg. Aug 2005;80(2):607-10. [Medline].

  30. Gerber TC, Safford RE. Intrapericardial Doppler flow signals in cardiac tamponade. Clin Cardiol. Mar 1999;22(3):231-2. [Medline].

  31. Girardi LN, Ginsberg RJ, Burt ME. Pericardiocentesis and intrapericardial sclerosis: effective therapy for malignant pericardial effusions. Ann Thorac Surg. Nov 1997;64(5):1422-7; discussion 1427-8. [Medline].

  32. Graham SJ, Duval-Arnould B, Mercado TC, Trepel JB, Cotelingam JD. Burkitt's lymphoma: a pericardial presentation. Cytopathology. 1990;1(4):239-42. [Medline].

  33. Hallman JR, Geisinger KR. Cytology of fluids from pleural, peritoneal and pericardial cavities in children. A comprehensive survey. Acta Cytol. Mar-Apr 1994;38(2):209-17. [Medline].

  34. Hoffmann U, Globits S, Schima W, et al. Usefulness of magnetic resonance imaging of cardiac and paracardiac masses. Am J Cardiol. Oct 1 2003;92(7):890-5. [Medline].

  35. Hudnall SD, Melez K, Galindo A, Bryson Y. Massive pseudolymphomatous pericardial effusion in the posttransplant setting mimicking posttransplant lymphoproliferative disease. Transplantation. Jun 27 1996;61(12):1776-8. [Medline].

  36. Karimi M, Eshghi P. Unusual lymphoblastic leukemia/lymphoma in Eastern Iran. Indian J Pediatr. Jul 2006;73(7):619-22. [Medline].

  37. Kawakami K, Horigome H, Tsuchida M, et al. Right atrial hemangiopericytoma with hemopericardium during infancy. Pediatr Cardiol. Jan-Feb 1995;16(1):48-50. [Medline].

  38. Kondo M, Kojima S, Horibe K, et al. Hemolytic uremic syndrome after allogeneic or autologous hematopoietic stem cell transplantation for childhood malignancies. Bone Marrow Transplant. Feb 1998;21(3):281-6. [Medline].

  39. Krikorian JG, Hancock EW. Pericardiocentesis. Am J Med. Nov 1978;65(5):808-14. [Medline].

  40. Kulthe SG, Nadkarni UB, Singh A, et al. Recurrent Cardiac tamponade: intrapericardial teratoma. Indian Pediatr. Jan 1995;32(1):88-91. [Medline].

  41. Laga S, Gewillig MH, Van Schoubroeck D, Daenen W. Imminent fetal cardiac tamponade by right atrial hemangioma. Pediatr Cardiol. Sep-Oct 2006;27(5):633-5. [Medline].

  42. Lazzarino M, Orlandi E, Paulli M, et al. Treatment outcome and prognostic factors for primary mediastinal (thymic) B-cell lymphoma: a multicenter study of 106 patients. J Clin Oncol. Apr 1997;15(4):1646-53. [Medline].

  43. Lin YW, Kubota M, Matsumura M, et al. T cell leukemia with pericardial effusion at diagnosis. Pediatr Hematol Oncol. Oct-Dec 1993;10(4):379-80. [Medline].

  44. Lindenberger M, Kjellberg M, Karlsson E, Wranne B. Pericardiocentesis guided by 2-D echocardiography: the method of choice for treatment of pericardial effusion. J Intern Med. Apr 2003;253(4):411-7. [Medline].

  45. Loire R, Saint-Pierre A. Radiation-induced pericarditis. Long-term outcome. 45 cases with thoracotomy and biopsy [in French]. Presse Med. Dec 8 1990;19(42):1931-6. [Medline].

  46. Luna A, Ribes R, Caro P, et al. Evaluation of cardiac tumors with magnetic resonance imaging. Eur Radiol. Jul 2005;15(7):1446-55. [Medline].

  47. MacKenzie S, Loken S, Kalia N, et al. Intrapericardial teratoma in the perinatal period. Case report and review of the literature. J Pediatr Surg. Dec 2005;40(12):e13-8. [Medline].

  48. Maisch B, Pankuweit S, Brilla C, et al. Intrapericardial treatment of inflammatory and neoplastic pericarditis guided by pericardioscopy and epicardial biopsy--results from a pilot study. Clin Cardiol. Jan 1999;22(1 Suppl 1):I17-22. [Medline].

  49. Malamou-Mitsi VD, Zioga AP, Agnantis NJ. Diagnostic accuracy of pericardial fluid cytology: an analysis of 53 specimens from 44 consecutive patients. Diagn Cytopathol. Sep 1996;15(3):197-204. [Medline].

  50. Manetti A, De Simone L, Pollini I, et al. Generalized lymphangiomatosis with chylopericardium [in Italian]. Pediatr Med Chir. Jan-Feb 1994;16(1):81-3. [Medline].

  51. Marcy PY, Bondiau PY, Brunner P. Percutaneous treatment in patients presenting with malignant cardiac tamponade. Eur Radiol. Sep 2005;15(9):2000-9. [Medline].

  52. Markiewicz W, Glatstein E, London EJ, Popp RL. Echocardiographic detection of pericardial effusion and pericardial thickening in malignant lymphoma. Radiology. Apr 1977;123(1):161-4. [Medline].

  53. Markman M. Common complications and emergencies associated with cancer and its therapy. Cleve Clin J Med. Mar-Apr 1994;61(2):105-14; quiz 162. [Medline].

  54. Martinez-Lopez JI. ECG of the month. The swinging heart. Electrical alternans. J La State Med Soc. Apr 1990;142(4):5-8. [Medline].

  55. McClain JL, Clark MA, Sandusky GE. Undiagnosed, untreated acute lymphoblastic leukemia presenting as suspected child abuse. J Forensic Sci. May 1990;35(3):735-9. [Medline].

  56. McDonald JM, Meyers BF, Guthrie TJ, et al. Comparison of open subxiphoid pericardial drainage with percutaneous catheter drainage for symptomatic pericardial effusion. Ann Thorac Surg. Sep 2003;76(3):811-5; discussion 816. [Medline].

  57. Meyers DG, Meyers RE, Prendergast TW. The usefulness of diagnostic tests on pericardial fluid. Chest. May 1997;111(5):1213-21. [Medline].

  58. Mihaescu A, Gebhard S, Chaubert P, et al. Application of molecular genetics to the diagnosis of lymphoid-rich effusions: study of 95 cases with concomitant immunophenotyping. Diagn Cytopathol. Aug 2002;27(2):90-5. [Medline].

  59. Mishra OP, Yusuf S, Ali Z, Nath G. Lysozyme levels for the diagnosis of tuberculous effusions in children. J Trop Pediatr. Oct 2000;46(5):296-300. [Medline].

  60. Moores DW, Allen KB, Faber LP, et al. Subxiphoid pericardial drainage for pericardial tamponade. J Thorac Cardiovasc Surg. Mar 1995;109(3):546-51; discussion 551-2. [Medline].

  61. Mouallem M, Wolf I, Mindlin G, Farfel Z. Pericardial tamponade-associated hyponatremia. Am J Med Sci. Jan 2003;325(1):51-2. [Medline].

  62. Mueller XM, Tevaearai HT, Hurni M, et al. Long-term results of surgical subxiphoid pericardial drainage. Thorac Cardiovasc Surg. Apr 1997;45(2):65-9. [Medline].

  63. Mukai K, Shinkai T, Tominaga K, Shimosato Y. The incidence of secondary tumors of the heart and pericardium: a 10- year study. Jpn J Clin Oncol. Sep 1988;18(3):195-201. [Medline].

  64. Nieh S, Chen SF, Fu E, et al. Detection of the human telomerase RNA component by in situ hybridization in cells from body fluids. Acta Cytol. Jan-Feb 2005;49(1):31-7. [Medline].

  65. Ohnishi M, Niwayama H, Miyazawa Y, et al. Echocardiography in patients with malignant metastatic neoplasms of the heart and great vessels [in Japanese]. J Cardiol. 1990;20(2):377-84. [Medline].

  66. Parwani AV, Ali TZ, Ali SZ. Pathologic quiz case: a 15-year-old adolescent girl with supraclavicular lymphadenopathy and pleural and pericardial effusions. Arch Pathol Lab Med. Jun 2003;127(6):e288-90. [Medline].

  67. Perkkio M, Tikanoja T, Marin S. Leukemic coronary artery occlusion in a child with acute lymphoblastic leukemia. Pediatr Cardiol. Jan-Feb 1997;18(1):64-5. [Medline].

  68. Politi E, Kandaraki C, Apostolopoulou C, et al. Immunocytochemical panel for distinguishing between carcinoma and reactive mesothelial cells in body cavity fluids. Diagn Cytopathol. Mar 2005;32(3):151-5. [Medline].

  69. Pomjanski N, Motherby H, Buckstegge B, et al. Early diagnosis of mesothelioma in serous effusions using AgNOR analysis. Anal Quant Cytol Histol. Apr 2001;23(2):151-60. [Medline].

  70. Posner MR, Cohen GI, Skarin AT. Pericardial disease in patients with cancer. The differentiation of malignant from idiopathic and radiation-induced pericarditis. Am J Med. Sep 1981;71(3):407-13. [Medline].

  71. Puthanakit T, Pongprot Y, Borisuthipandit T, et al. A mediastinal mass resembling lymphoma: an unusual manifestation of probable case of invasive zygomycosis in an immunocompetent child. J Med Assoc Thai. Oct 2005;88(10):1430-3. [Medline].

  72. Rienmuller R, Tiling R. Evaluation of paracardiac and intracardiac masses in children. Semin Ultrasound CT MR. Jun 1990;11(3):246-50. [Medline].

  73. Rinkevich D, Borovik R, Bendett M, Markiewicz W. Malignant pericardial tamponade. Med Pediatr Oncol. 1990;18(4):287-91. [Medline].

  74. Rosenkranz ER, Murphy DJ Jr. Diagnosis and neonatal resection of right atrial angiosarcoma. Ann Thorac Surg. Apr 1994;57(4):1014-5. [Medline].

  75. Shimoyama Y, Kawada K, Imamura H. A functioning intrapericardial paraganglioma (pheochromocytoma). Br Heart J. Apr 1987;57(4):380-3. [Medline].

  76. Sklansky M, Greenberg M, Lucas V, Gruslin-Giroux A. Intrapericardial teratoma in a twin fetus: diagnosis and management. Obstet Gynecol. May 1997;89(5 Pt 2):807-9. [Medline].

  77. Spottswood SE, Goble MM, Massey GV, Ben-Ezra JM. Acute monoblastic leukemia presenting with pericardial effusion and cardiac tamponade. Pediatr Radiol. 1994;24(7):494-5. [Medline].

  78. Szturmowicz M, Tomkowski W, Fijalkowska A, et al. Diagnostic utility of CYFRA 21-1 and CEA assays in pericardial fluid for the recognition of neoplastic pericarditis. Int J Biol Markers. Jan-Mar 2005;20(1):43-9. [Medline].

  79. Toren A, Nagler A. Massive pericardial effusion complicating the course of chronic graft- versus-host disease (cGVHD) in a child with acute lymphoblastic leukemia following allogeneic bone marrow transplantation. Bone Marrow Transplant. Nov 1997;20(9):805-7. [Medline].

  80. Vassilopoulos PP, Nikolaidis K, Filopoulos E, Griniatsos J, Efremidou A. Subxiphoidal pericardial 'window' in the management of malignant pericardial effusion. Eur J Surg Oncol. Oct 1995;21(5):545-7. [Medline].

  81. Wilkes JD, Fidias P, Vaickus L, Perez RP. Malignancy-related pericardial effusion. 127 cases from the Roswell Park Cancer Institute. Cancer. Oct 15 1995;76(8):1377-87. [Medline].

  82. Wong JW, Pitlik D, Abdul-Karim FW. Cytology of pleural, peritoneal and pericardial fluids in children. A 40-year summary. Acta Cytol. Mar-Apr 1997;41(2):467-73. [Medline].

  83. Woods T, Vidarsson B, Mosher D, Stein JH. Transient effusive-constrictive pericarditis due to chemotherapy. Clin Cardiol. Apr 1999;22(4):316-8. [Medline].

  84. Zendehrokh N, Dejmek A. Telomere repeat amplification protocol (TRAP) in situ reveals telomerase activity in three cell types in effusions: malignant cells, proliferative mesothelial cells, and lymphocytes. Mod Pathol. Feb 2005;18(2):189-96. [Medline].

  85. .

  86. Tsai MH, Yang CP, Chung HT, Shih LY. Acute myeloid leukemia in a young girl presenting with mediastinal granulocytic sarcoma invading pericardium and causing superior vena cava syndrome. J Pediatr Hematol Oncol. Dec 2009;31(12):980-2. [Medline].

  87. Devlieger R, Hindryckx A, Van Mieghem T, Debeer A, De Catte L, Gewillig M, et al. Therapy for foetal pericardial tumours: survival following in utero shunting, and literature review. Fetal Diagn Ther. 2009;25(4):407-12. [Medline].

  88. Singh J, Rana SS, Kaur A, Srivastava V, Singh H, Sharma R. Intrapericardial teratoma presenting as recurrent pericardial tamponade: report of a case. Surg Today. 2009;39(8):700-4. [Medline].

  89. Palma JH, Gaia DF, Guilhen JC, Branco JN, Buffolo E. Video-thoracoscopic pericardial drainage in the treatment of pericardial effusions. Rev Bras Cir Cardiovasc. Mar 2009;24(1):44-9. [Medline].

  90. Walsh MA, Carcao M, Pope E, Lee KJ. Kaposiform hemangioendothelioma presenting antenatally with a pericardial effusion. J Pediatr Hematol Oncol. Oct 2008;30(10):761-3. [Medline].

 
Previous
Next
 
Plain chest radiograph in a 3-month-old infant with pneumonia and malignant pericardial effusion showing cardiomegaly and bilateral pneumonic patches.
Two-dimensional echocardiograph from a subcostal window showing a large pericardial effusion.
M-mode echocardiograph in a child with pericardial effusion.
Cytologic features of malignant pericardial effusion. Smear of centrifuged pericardial fluid in a patient with malignant pericardial involvement from lymphoma. Low-power view showing numerous mononuclear cells along with large atypical malignant cells.
Cytologic features of malignant pericardial effusion. Smear of centrifuged pericardial fluid in a patient with malignant pericardial involvement from lymphoma. High-power view showing morphologic details of the malignant cells. These cells are large and show oval hyperchromatic nuclei, some of them having nucleoli. The cytoplasm is reduced to a thin rim.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.